Improving Independence – can homecare re-ablement make a difference in the longer term?

1. Improving Independence – can homecare re-ablement make a difference in the longer term? Liz Newbronner

2. CSED Homecare Re-ablement Workstream • 2006 CSED study into the development of homecare re-ablement in England • Working definition of re-ablement used by CSED: ‘Services for people with poor physical or mental health to help them accommodate their illness by learning or re-learning the skills necessary for daily living’ • Study showed that: • 60 CASSR had a homecare re-ablement service of some kind • Characteristics of these services varied considerably • Main distinction was between ‘intake’ and ‘discharge’ or ‘discharge support’ services

3. Background to the Study • Limited evidence base about effectiveness of homecare re-ablement • Indications of reductions in use of homecare services following ‘discharge’ from re-ablement • But no evidence on: - longer term duration of reductions - factors that impact on subsequent service use

4. Aims of the Study 1. To use routine service data from CASSRs to examine changes over time in subsequent use of social care services following homecare re-ablement 2. To identify factors that may affect subsequent use of social care services following homecare re-ablement 3. To consider the focus and research design of a larger evaluation of homecare re-ablement services

5. Methods Selected 4 CASSRs with re-ablement services (2 ‘intake’ and 2 ‘discharge’) established for at least 4 years. In each site: • Analysis of routine data for clients with an episode of homecare re-ablement in 2004-5, including subsequent social care provision (2005-6 and 2006-7) • Interviews with homecare re-ablement service manager and colleagues • Interviews with one or more care management team managers in each site

6. The Study Sites • Wirral Enablement Discharge Service (WEDS), Wirral Metropolitan Borough Council (‘discharge support’) • Homecare Assessment and Re-ablement Team (HART), Leicestershire County Council (‘intake’) • Short Term Assessment and Re-ablement Team (START), London Borough of Sutton (primarily ‘discharge support’) • Intermediate Home Support Service (IHS), Salford City Council (‘intake’)

7. Profile of Re-ablement Service Users • Four age groups used – up to 64; 65 to 74; 75 to 84; and 85 and over • Percentage of service users in each age group broadly similar for all four sites • Longer established services (Leicestershire and Sutton) had higher proportion in the 85 and over age group • In all four sites 80% of service users were categorised as ‘physical disability’, ‘physical illness’ or ‘physical frailty’

8. Overall Pattern of Homecare and Re-ablement Service Use • Between a third and a half of service users in Salford, Leicestershire and Sutton had reablement only • Percentage of users who had re-ablement followed by homecare was remarkably consistent across the sites at just over 40% • Two most ‘mature’ services had the greatest proportion of service users who had homecare before re-ablement

9. Time from Re-ablement to First Episode of Homecare • Majority of service users who had homecare had their first episode within one week of leaving re-ablement • For service users starting homecare later, there are two ‘peaks’ in take up: at the ‘up to three months’ point; at the ‘over one year’ point • Patterns may suggest re-ablement users fall into two broad groups: - those gaining immediate but relatively short-term benefit avoiding need for homecare for a few months - those for whom impact is more sustained and which delays the need for homecare by a year or more

11. Change in Homecare Use After Re-ablement • Examined the changes in the use of homecare after re-ablement • Used snapshot points of 3, 6, 12, 18 & 24 months after re-ablement • In Leicestershire and Sutton, percentage of service users needing less homecare than they did on leaving re-ablement increased over the two years • In Salford, percentage of service users needing less homecare than they did on leaving re-ablement fell after 18 months but percentage of service users needing progressively more homecare was only slightly higher at end of 2-year period • Wirral is very different but still appears to be a significant change at the 18-month point

12. Change in homecare use – all service users

13. Change in homecare use – over 85 age group Excludes those who died or went into permanent residential care

14. Intensity of Homecare Use after Reablement • Examined the intensity of homecare usage after re-ablement at the snapshot points of 3, 6, 12, 18 and 24 months • Based analysis on hours of homecare ‘categories’ used in HH1 returns (2 hours or less; 2-5 hours; 6-10 hours; and 10+ hours) • Overall no marked changes in the proportions of service users in each category at the different snapshot points • Leicestershire had the smallest proportion of users in the ‘more than 10 hours’ group

15. Factors Affecting the Longer-Term Impact of Re-ablement • Independent providers – culture and contracting arrangements • Culture • Staff training • Time and tasks commissioned • Contracting system • Frequency of review • Re-ablement package – duration and flexibility • Service users – understanding and attitudes • Carers – perceptions of risk and on-going support • Signposting to other services and support • Culture of re-ablement across social care services

16. Key Lessons for CASSRs establishing Re-ablement Services • Staff attitudes, skills and training • Communicating the re-ablement ethos • Capacity and throughput • Flexibility • Access to the re-ablement service • Skill mix and relationship to other professionals • Relationships with carers • Role in assessment/review • A ‘whole systems’ approach

17. Key Lessons for CASSRs establishing Re-ablement Services • Staff attitudes, skills and training • Communicating the re-ablement ethos • Capacity and throughput • Flexibility • Access to the re-ablement service • Skill mix and relationship to other professionals • Relationships with carers • Role in assessment/review • A ‘whole systems’ approach

18. Contact Details Liz Newbronner – liz@actonshapiro.co.uk Websites: www.csed.csip.org.uk www.york.ac.uk/spru www.actonshapiro.co.uk